Betty Clooney Center: Serving Persons with Traumatic Brain Injury with TBISince 1983
Map indicating Los Angeles California

SSDI Benefits

Head in scattered pieces

Traumatic Brain Injury and Social Security Disability Benefits

A traumatic brain injury happens when an outside force impacts the body and injures the brain. Brain injuries can have a wide range of symptoms and, in severe cases, can be permanently disabling. If you or a loved one has experienced a brain injury and can no longer work, you may be eligible to receive disability benefits.

Unfortunately, many people with TBI miss out on these benefits because the application process is time-consuming and complex. For this reason, we have provided you with the following article. It offers a general overview of Social Security Disability benefits and will prepare you to begin the application process. Continue reading to see if you or a loved one qualifies.

Benefit Options

The Social Security Administration (SSA) oversees several different disability benefits programs, each intended to serve specific types of applicants. These programs are Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

SSDI benefits are offered to disabled workers and their eligible family members. To qualify, applicants are required to have worked and paid Social Security taxes for a significant period of time. Because of this, these benefits are typically best suited to adults with extensive work experience. To learn more about SSDI eligibility, visit the following page: http://www.disability-benefits-help.org/glossary/social-security-disability-insurance-ssdi

SSI benefits, on the other hand, are offered to disabled individuals who earn very little income. To qualify, applicants must fall within the financial parameters set by the SSA. Because this program has no work or tax-related requirements, it is often a good fit for children and adults who haven’t had the opportunity to pay Social Security taxes. Learn more, here: http://www.socialsecurity.gov/ssi/text-eligibility-ussi.htm.

Be sure to research each of these programs and select the one that best matches your circumstances. Unfortunately, if you do not meet the work or financial requirements for either program, you will not be eligible to receive disability benefits.

Medical Requirements

Those who do meet the technical requirements will have to meet additional medical criteria. The most basic of these is meeting the SSA’s standard of disability. To be considered disabled you will need to meet these three criteria:

  • You cannot do work that you did prior to becoming disabled; and
  • You have a physical or mental condition that prevents you from learning new types of work; and
  • Your disability has lasted or is expected to last for at least one year or to result in death.

Beyond meeting the broad definition of disability, you will also be required to meet criteria to your specific condition. These criteria can be found in the SSA’s official guidebook of disabling conditions—the Blue Book. The Blue Book contains listings for disabilities and conditions that qualify for disability benefits. Each listing outlines the medical requirements for that particular condition.

Traumatic brain injuries will primarily qualify under Blue Book listing 11.18—Cerebral Trauma. This listing states that applicants with traumatic brain injuries will be evaluated based on a listing associated with their particular condition. These include the following:

  • 11.02—Convulsive Epilepsy;
  • 11.03—Non-convulsive Epilepsy;
  • 11.04—Central Nervous System Vascular Accident (Stroke); or
  • 12.02—Organic Mental Disorders

It is important to look through each of these listings to make sure that you qualify medically. If you do not understand the medical or technical terminology used in the Blue Book, it may be in your best interest to schedule an appointment with your doctor. He or she will be able to explain the requirements and can perform the tests necessary to confirm your eligibility

If you do not meet this Blue Book listing, you may still be able to qualify for disability benefits under a medical vocational allowance. This means that the SSA will evaluate your age, your previous job training, and your functional abilities to determine whether or not you are able to work. If the SSA decides that you are unable to work, you will likely be awarded benefits.

Application Preparation and Submission

If you meet the technical and medical requirements for disability benefits, you will have to provide the SSA with medical and non-medication documentation to support your claim. Medical documentation should include, but is not limited to:

  • Records of your diagnosis
  • Findings of physical and mental examinations
  • Lab tests and results
  • Medical images- MRI, CT, or X-ray
  • A history of hospitalizations
  • Record of your treatments and responses to them
  • Written statements from your doctors

Medical records are very important because they serve as proof of your condition. Without them, your claim may be delayed or even denied. Required non-medical documentation should include various forms of identification, financial statements, and employment records. For a complete list of necessary items, visit the following page: http://www.socialsecurity.gov/disability/Documents/Checklist%20-%20Adult.pdf.

Once you are prepared to begin the application process, you can apply online or in person at a local Social Security office. If an applicant is unable to complete the application on their own, a family member, friend, or caretaker can submit an application on his or her behalf. When completing the required forms, you should take your time and include as much relevant information as possible. Your application should provide the SSA with insight into your day-to-day life with a traumatic brain injury.

Receiving a Decision

After submitting an application for disability benefits, you will not receive a decision for several months. If you are approved, you will receive a letter in the mail outlining your award and payment schedule. Unfortunately, more than half of all initial disability applicants are denied. If this happens to you, you will have 60 days to appeal the SSA’s decision. If you exceed this time limit, you will be forced to begin the application process all over again.

Although it can be discouraging to receive a denial, the appeals process is often a necessary step toward being approved for disability benefits. In fact, many more applicants are approved during the appeal process than after the initial application submission. The key to being approved is to remain persistent and organized. Once you receive benefits, you will be able to focus on your health rather than your finances.

For more information about applying for disability benefits after a traumatic brain injury, visit the following page: http://www.disability-benefits-help.org/disabling-conditions/traumatic-brain-injury-and-social-security-disability.

Disclaimer